Political commentator Lynette “Diamond” Hardaway passed away on January 8 at the age of 51—and the cause of death has now been confirmed as heart disease due to chronic high blood pressure. The American Heart Association reports nearly half of all Americans have some sort of cardiovascular disease, which is the number one cause of death in the US. High blood pressure, known as hypertension, is a major risk factor for heart disease. 

“As one of the most common and dangerous risk factors for heart disease and stroke, this overwhelming presence of high blood pressure can’t be dismissed from the equation in our fight against cardiovascular disease,” says Dr. Ivor J. Benjamin, volunteer president of the American Heart Association and director of the Cardiovascular Center at the Medical College of Wisconsin in Milwaukee. “Research has shown that eliminating high blood pressure could have a larger impact on CVD deaths than the elimination of all other risk factors among women and all except smoking among men.”

Heart disease is scary, but doctors say it is preventable—which is why knowing the symptoms is crucial for good health. “I think one of the most important things we can do is tell everyone that heart disease is preventable,” says cardiologist Leslie Cho, MD. “90% of the time you can prevent your heart disease. It doesn’t matter your genetic makeup, you can really do something about preventing heart disease. By knowing your numbers, like your blood pressure, your cholesterol, your glucose numbers, and keeping your weight down and exercising, you can really change the course of your health.” Here are five signs of heart disease, according to experts. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Chest pain is a common symptom of heart disease. “When coronary arteries become narrow, the heart doesn’t get enough oxygen-rich blood,” says Stephen Kopecky, MD. “Remember, unlike most pumps, the heart has to pump its own energy supply. It’s working harder with less. And you may begin to notice these signs and symptoms of pressure or tightness in your chest. This pain is called angina. It may feel like somebody is standing on your chest.”

“The symptoms can be variable but patients generally describe a dull ache or heaviness, or tightness, in the chest which can also be felt in the neck, jaw or arms and sometimes the back and stomach area,” says Dr Sarah Clarke, an interventional cardiologist at Papworth Hospital in Cambridge. “It’s usually triggered by exercise, emotional upset, or you might experience an attack after eating or in cold weather. The symptoms can sometimes be mistaken for indigestion.”

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Trouble breathing is another symptom of heart disease. “Many people who have heart conditions experience shortness of breath every day,” say Dr. Ann Hutchinson, and Professor Miriam Johnson. “Heart conditions such as angina, heart attacks, heart failure and some abnormal heart rhythms like atrial fibrillation can all cause shortness of breath. These conditions may cause breathlessness for different reasons. If your heart isn’t pumping enough oxygen-containing blood around the body, your body responds by breathing faster to try to get more oxygen into your body, making you feel short of breath. Or if your heart isn’t working as well as it should, this could cause a build-up of fluid in the lungs, making it difficult to breathe. ”   

As with all heart disease symptoms, trouble breathing should never be ignored. “When your heart can’t pump enough blood to meet your body’s needs, you might develop shortness of breath or extreme fatigue during activities,” says Dr. Kopecky. “And if an artery becomes totally blocked, it leads to a heart attack. Classic signs and symptoms of a heart attack include crushing, substernal chest pain, pain in your shoulders or arms, shortness of breath, and sweating. However, many heart attacks have minimal or no symptoms and are found later during routine testing.”

Fatigue could be a symptom of heart disease. “We’re not talking about global fatigue like you feel tired at the end of the day,” says Dr. Cho. “We’re not talking about you needing to go take a nap at 5 o’clock. We’re talking about you were able to walk up a couple of flights of stairs — and now you can barely walk up one. Or you can’t walk upstairs without feeling severe fatigue.” 

Not being able to do things that were always easy before is a major red flag. “You might notice that when you’re walking around the block taking your dog out, you’ll become very short-winded where you weren’t before,” Dr. Cho says. “Walking to your car, you’ll get very, very short-winded. It’s a significant change in your functional status, is how I would put it. You were able to be on the treadmill 20 minutes, but now you can barely do 10 because you just feel so tired.”

Unexplained arm or leg pain could be a sign of heart disease. “If you get a gripping, cramping sensation in your calves when you are walking, it might be worth seeing your doctor, as that can be a marker of PAD (peripheral arterial disease). It’s most common in smokers and people who have diabetes,” says David Newby, BHF John Wheatley Professor of Cardiology at the BHF Centre of Research Excellence at the University of Edinburgh. “If your pain is going down the arm, especially the left arm, or into the neck that makes it more likely to be heart-related than indigestion. If it doesn’t go away, or if you know you have heart disease and have used your GTN (glyceryl trinitrate) spray two or three times to no discernible effect, you should be seeking emergency medical advice.”

Swollen ankles could be another warning sign. “This shouldn’t be ignored, especially if the ankles get really big, as it can be a marker of heart failure, but it is also very common and has lots of other causes. It could just as easily be from tablets you are taking – for example, blood pressure medication can lead to swollen ankles.”

“There are a number of risk factors, common red flags, that can contribute to this and ultimately lead to coronary artery disease,” says Dr. Kopecky. “First, getting older can mean more damaged and narrowed arteries. Second, men are generally at a greater risk. But the risk for women increases after menopause. Existing health conditions matter, too. High blood pressure can thicken your arteries, narrowing your blood flow. High cholesterol levels can increase the rate of plaque buildup.”

Lifestyle factors can also affect heart health. “Diabetes is also associated with higher risk, as is being overweight. Your lifestyle plays a large role as well. Physical inactivity, long periods of unrelieved stress in your life, an unhealthy diet and smoking can all increase your risk. And finally, family history. If a close relative was diagnosed at an early age with heart disease, you’re at a greater risk. All these factors together can paint a picture of your risk for developing CAD.”